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Fly Home
Companion Services, LLC
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FH-CL-003 • VERSION 1.0
Client Service Agreement
Services, schedule, fees, boundaries, responsibilities and signatures.
Digital workflow:
Complete required fields, review carefully, then submit. A submitted record is timestamped and preserved for office review.
1. Record identification
Client name *
Date *
Completed by *
2. Parties & services
Client / responsible party
Authorized service categories
Service location
Days / times
Minimum visit length
3. Rates, billing & cancellation
Hourly rate
Mileage
Holiday rate
Other fees
Billing frequency
Payment method
Payment due / late terms
Cancellation window / late-cancel terms
4. Acknowledgments
Agreement acknowledgments *
Non-medical scope and prohibited services
Support With, Not Take Over philosophy
Written Service Plan
Reminder-only medication limits
Emergency and fall procedure
Separate authorization for transportation and client funds
Safe environment and respectful conduct
Privacy and professional boundaries
Client Rights & Responsibilities
Complaint process and reporting obligations
5. Termination & signatures
Notice terms / immediate safety termination
Client / representative signature *
Fly Home representative *
Date *
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